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Disordered proliferative endometrium (view source)
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'''Disordered proliferative endometrium''', abbreviated '''DPE''', is an abnormal [[endometrium|endometrial]] finding with some features of [[simple endometrial hyperplasia]]. | |||
==General== | |||
*Association: anovulation. | |||
*Benign - can be grouped with ''normal''.<ref name=pmid18580308>{{Cite journal | last1 = Sherman | first1 = ME. | last2 = Ronnett | first2 = BM. | last3 = Ioffe | first3 = OB. | last4 = Richesson | first4 = DA. | last5 = Rush | first5 = BB. | last6 = Glass | first6 = AG. | last7 = Chatterjee | first7 = N. | last8 = Duggan | first8 = MA. | last9 = Lacey | first9 = JV. | title = Reproducibility of biopsy diagnoses of endometrial hyperplasia: evidence supporting a simplified classification. | journal = Int J Gynecol Pathol | volume = 27 | issue = 3 | pages = 318-25 | month = Jul | year = 2008 | doi = 10.1097/PGP.0b013e3181659167 | PMID = 18580308 }}</ref> | |||
Treatment: | |||
*Progesterone<ref name=pmid16873562/> versus observation.<ref name=pmid17090792>{{Cite journal | last1 = Ely | first1 = JW. | last2 = Kennedy | first2 = CM. | last3 = Clark | first3 = EC. | last4 = Bowdler | first4 = NC. | title = Abnormal uterine bleeding: a management algorithm. | journal = J Am Board Fam Med | volume = 19 | issue = 6 | pages = 590-602 | month = | year = | doi = | PMID = 17090792 | url = http://www.jabfm.org/content/19/6/590.full }}</ref> | |||
Image: | |||
*[http://www.jabfm.org/content/19/6/590/F8.expansion.html Treatment algorithim based on endometrial biopsy results (jabfm.org)].<ref name=pmid17090792/> | |||
==Microscopic== | |||
Features:<ref name=Ref_PBoD1080>{{Ref PBoD|1080 and 1082}}</ref> | |||
*Proliferative type endometrium with: | |||
**Cystic dilation of glands focally that do not have (glandular) secretions - '''key feature'''. | |||
***Glands >2x normal size - usually 3-4x normal. | |||
***Irregular shape, e.g. gland contour has inflection points. | |||
***Greater than fours glands involved (dilated). | |||
*+/-Stromal condensation -- balls of stromal tissue, aka "blue balls" (due to breakdown of endometrium). | |||
Notes: | |||
*Dilated glands often have tubal metaplasia.{{fact}} | |||
*Eosinophilic syncytial metaplasia - common. | |||
**Features: abundant eosinophilic cytoplasm, mild nuclear atypia +/-loss of nuclear stratification, no mitoses). | |||
DDx: | |||
*[[Proliferative phase endometrium]]. | |||
**Glands: straight, tubular, tall pseudostratified columnar cells, mitotic figures, no vacuolation, no mucus secretion, abundant mitoses. | |||
**Stroma: cellular, stroma (spindle cells), mitoses. | |||
*[[Simple endometrial hyperplasia]] without atypia - architectural atypia diffuse. | |||
*[[Benign endometrial polyp]]. | |||
===Images=== | |||
www: | |||
*[http://www.sciencedirect.com/science/article/pii/S0740257010000997#fig15 DPE (sciencedirect.com)]. | |||
*[http://www.sciencedirect.com/science/article/pii/S0740257010000997#fig18 DPE (sciencedirect.com)]. | |||
*[http://www.glowm.com/resources/glowm/uploads/1225247516_03-50291-007_small.jpg DPE (glowm.com)].<ref name=glowm>URL: [http://www.glowm.com/index.html?p=glowm.cml/section_view&articleid=235 http://www.glowm.com/index.html?p=glowm.cml/section_view&articleid=235]. Accessed on: 11 December 2012.</ref> | |||
*[http://www.hsc.stonybrook.edu/gyn-atlas/UT3431B.htm DPE (stonybrook.edu)]. | |||
<gallery> | |||
Image:Endometrial_stromal_condensation_high_mag.jpg | Endometrial stromal condensation - high mag. (WC/Nephron) | |||
</gallery> | |||
==Sign out== | |||
<pre> | |||
ENDOMETRIUM, BIOPSY: | |||
- DISORDERED PROLIFERATIVE ENDOMETRIUM. | |||
</pre> | |||
====With endocervix==== | |||
<pre> | |||
ENDOMETRIUM, BIOPSY: | |||
- DISORDERED PROLIFERATIVE ENDOMETRIUM. | |||
- BENIGN ENDOCERVICAL MUCOSA. | |||
</pre> | |||
====Waffle a bit==== | |||
<pre> | |||
ENDOMETRIUM, BIOPSY: | |||
- COMPATIBLE WITH DISORDERED PROLIFERATIVE ENDOMETRIUM (FRAGMENTS OF PROLIFERATIVE | |||
ENDOMETRIUM WITH EVIDENCE OF SHEDDING AND VERY RARE GLAND DILATION). | |||
- VERY SCANT STRIPPED ENDOCERVICAL EPITHELIUM WITHOUT APPARENT PATHOLOGY. | |||
- NEGATIVE FOR ENDOMETRIAL HYPERPLASIA. | |||
- NEGATIVE FOR MALIGNANCY. | |||
</pre> | |||
<pre> | |||
ENDOMETRIUM, CURETTAGE: | |||
- PROLIFERATIVE ENDOMETRIUM, FOCALLY WITH GLAND DILATION AND SMALL BLOOD | |||
VESSELS, SEE COMMENT. | |||
- NEGATIVE FOR HYPERPLASIA AND NEGATIVE FOR MALIGNANCY. | |||
COMMENT: | |||
A fibrotic stroma is not present. The findings may represent a remnant of the previously | |||
excised endometrial polyp or disordered proliferative endometrium. Follow-up is suggested. | |||
</pre> | |||
===Micro=== | |||
The sections show a well-sampled endometrium. Mitotic figures are identified within the | |||
glands and stroma. Irregular, moderately enlarged glands are seen (only) in one of several | |||
fragments; most of the endometrial glands are round, regular and small. | |||
No stromal condensation is apparent. No secretions are in the glands. | |||
There are no back-to-back glands. No nuclear atypia is apparent. No thick-walled blood | |||
vessels are apparent. | |||
==See also== | |||
*[[Endometrium]]. | |||
==References== | |||
{{Reflist|2}} | |||
[[Category:Endometrium]] | |||
[[Category:Diagnosis]] | [[Category:Diagnosis]] | ||